FSA-413 and FSA-41 EGSFP Application

OMB Control Number: 0560-0315
Expiration Date: 09/30/2023

FSA-413

U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency

(03-16-23)

FOR COUNTY OFFICE USE ONLY
1. Administrative State
Name

EMERGENCY GRAIN STORAGE FACILITY
ASSISTANCE PROGRAM (EGSFP) APPLICATION

2. Administrative County
Code

Name

3. Program Year

Code

4. Application Number

2023

PART A - APPLICANT'S INFORMATION
5A. Applicant's Name (Person or Legal Entity)

5G. Applicant's CCID Number (For County Office Use Only)

5B. Address Line 1

5H. Primary Phone Number

Home

Cell

5C. Address Line 2

5I. Alternate Phone Number

Home

Cell

5D. City

5E. State 5F. Zip

5K. Do you meet the definition of an Underserved Producer?

5L. Disbursement Type
Final

Partial/Final

NO

YES

5J. Email Address (Optional)

5M. Applicant's Signature (By)

5N. Title/Relationship of Individual if Signing in
Representative Capacity

5O. Date of Applicant's
Signature

6. I certify the producer listed in Item 5A is a U.S. Citizen, Resident Alien, Foreign Person or a legal entity including a corporation, LLC,
LP, trust, estate, general partnership or joint venture, or similar type entity, comprised solely of persons who are U.S. Citizen, Resident
Aliens, or Foreign Persons and meet all other EGSFP requirements.
YES

NO

PART B - CONTACT PRODUCER'S INFORMATION
7A. Contact Producer's Name
7B. Address Line 1

7G. Primary Phone Number

Home

Cell

7C. Address Line 2

7H. Alternative Phone Number

Home

Cell

7E. State

7D. City

7F. Zip

7I. Email Address (Optional)

PART C - EGSFP ELIGIBILITY FOR ON-FARM GRAIN STORAGE STRUCTURE AND/OR DRYING/HANDLING
EQUIPMENT INFORMATION

8. Did all applicants harvest grain in an affected county eligible for EGSFP assistance? Producers only in affected counties are
eligible for EGSFP assistance. See link for eligible impacted areas: Farm Storage Facility Loan Program (usda.gov)
YES
NO

If YES, list names of affected counties for all applicants:
If NO, explain in remarks.

9. All applicants agree that; (1) they were actively producing and marketing grain when the eligible disaster event(s) occurred;
(2) they are still actively producing grain; (3) they will use the storage, drying/handling equipment for at least 3 years after the
EGSFP payment is issued.
YES
DATE STAMP
NO

If NO, explain in remarks.

FSA-413 (03-16-23)

Page 2 of 5

PART C - EGSFP ELIGIBILITY FOR ON-FARM GRAIN STORAGE STRUCTURE AND/OR DRYING/HANDLING
EQUIPMENT INFORMATION (Continuation)
10. Completely describe the on-farm grain storage structure and/or drying/handling equipment that will be purchased for the
on-farm grain storage capacity.

11. What is the physical address of where the on-farm grain storage structure will be installed or where the drying/handling
equipment will be stored?

12. List all grain crops produced for the applicant and co-applicants that require on-farm grain storage and/or drying/handling
equipment.

PART D - CERTIFICATION OF APPLICANT/CO-APPLICANT'S ON-FARM GRAIN STORAGE CAPACITY NEED
The applicant and co-applicants certify to the following on-farm grain storage capacity need below.
13A. Total crop year 2021 and 2022 harvested grain production combined for applicant and co-applicants.
13B. Total on-farm grain storage capacity (Bushels) owned by the applicant and co-applicants. Enter N/A if
this request is only for drying/handling equipment.
13C. Total on-farm grain storage capacity (Bushels) needed for applicant and co-applicants.
(Item 13A minus Item 13B). Enter N/A if this request is only for drying/handling equipment.
13D. Total capacity of the on-farm grain storage structure (Bushels) to be constructed. If Item 13D is greater
than Item 13C, then Item 13C will be used to determine the on-farm grain storage capacity need for
EGSFP assistance. Enter N/A if this request is only for drying/handling equipment.
13E. Total amount of grain to be dried and/or handled, if requesting only drying and/or handling equipment.
Enter N/A if this request is only for an on-farm grain storage structure.

PART E - REQUEST FOR EGSFP ASSISTANCE
14. Applicant and co-applicant's request the estimated dollar amount

for the EGSFP assistance described

in Item 10.
15A. Applicant/Co-Applicant's Name

PART F - REMARKS
16. Enter any remarks.

15B. Applicant/Co-Applicant's Share of Grain in Item 13D or
Item 13E (as applicable)

Page 3 of 5

FSA-413 (03-16-23)

PART G - EGSFP AGREEMENT

The undersigned applicant and co-applicants request assistance under the Emergency Grain Storage Facility Assistance Program (EGSFP).
The undersigned certifies that all of the information entered on this form, whether personally entered by the undersigned, or by someone else
on the undersigned's behalf, is true and correct. The undersigned certifies and acknowledges that the grain production and storage capacity on
this form is accurately identified by the applicant and the co-applicant's share. The undersigned understands the information entered on this
form may be subject to verification by spot-check. The failure to certify any information on this form and application accurately may result in loss
of program benefits. Additionally, by signing this form, the undersigned (1) agrees to comply with all terms and conditions associated with
EGSFP as stated in the notice of funds availability (EGSFP NOFA); (2) certifies they have documentation to support this application and that
FSA can demand documentation to support the application for 3 years after the date of application; (3) agrees FSA will determine whether the
documentation meets program requirements; (4) authorizes FSA access to the site of the on-farm grain storage structure and/or drying/handling
equipment; (5) agrees that the on-farm grain storage structure and/or drying/handling equipment described must have a useful life of at least 3
years; (6) understands that any costs associated with the purchase or construction of on-farm grain storage and/or grain drying/handling
equipment prior to March 16, 2023 is ineligible for an EGSFP payment and the applicant has omitted any such costs from the request in Part E;
(7) understands EGSFP payments made to an eligible person or legal entity, other than a joint venture or general partnership, may not exceed
$125,000; (8) acknowledges that FSA will determine if the self-certified cost for the on-farm grain storage structure and drying and handling
equipment is reasonable based on general construction, labor, and supply rates for the respective areas; (9) agrees to comply with any
applicable local zoning, land use, and building codes for the applicable on-farm grain storage structure; (10) within 30 calendar days of signing
this application agree to complete and submit the following forms, if not already on file with FSA:
• Manual Form CCC-902-I, Farm Operating Plan for an Individual, as applicable
• Manual Form CCC-902E, Farm Operating Plan for an Entity, as applicable
• CCC-901, Member Information for Legal Entities (if applicable)
• AD-1026, Highly Erodible Land Conservation (HELC) and Wetland Conservation (WC) Certification
• AD-2047, Customer Data Worksheet
• CCC-860, Socially Disadvantaged, Limited Resource, Beginning and Veteran Farmer of Rancher Certification (if applicable)
This application will not be considered complete until the applicant and co-applicants that have a share of the EGSFP production have
completed all required items and signed in Part A or the continuation page, as applicable. Failure of an individual, entity, or member of an entity
to timely submit all information required may result in no payment or a reduced payment.
EGSFP payments will be subject to the availability of funding.

PART H - COC/STC - DETERMINATION (FOR COUNTY OFFICE USE ONLY)
17A. COC/STC Action on
Request for EGSFP Assistance
Approved

17B. Signature of COC/STC
Representative

17C. Title/Position of COC/STC
Representative

17D. Date Signed

Disapproved

PART I - REQUEST FOR EGSFP PARTIAL PAYMENT (If Applicable)
18. The undersigned request a partial EGSFP payment in the amount of

. The undersigned certify they

(a) have read, understand, and agree to the EGSFP requirement in Part G - EGSFP AGREEMENT; (b) completed a commensurate
share, up to 50 percent, of the construction or purchase of the eligible on-farm grain storage structure and/or drying/handling equipment
as described in Part C; (c) understand an FSA employee may inspect and verify the amount of construction completed and/or
purchased, before or after a partial EGSFP payment is disbursed; (d) understand the payment requested in this item will be based on
applicant/co-applicant's share, cost-share factor and provisions in Part G, as well as subject to the terms of the EGSFP NOFA. The
partial payment may not exceed 50 percent of the total estimated EGSFP payment.

19A. Applicant/Co-Applicant's Signature (By)

19B. Title/Relationship of Individual if Signing in 19C. Date of Applicant/
a Representative Capacity
Co-Applicant's Signature

PART J - COC/STC DETERMINATION - EGSFP PARTIAL PAYMENT (If Applicable)
(FOR COUNTY OFFICE USE ONLY)
20A. COC/STC Determination

Approved

Disapproved

20B. Signature of COC/STC
Representative

20C. Title/Position of COC/STC
Representative

20D. Date Signed

FSA-413 (03-16-23)

Page 4 of 5

PART K - REQUEST FOR EGSFP FINAL PAYMENT
21. The undersigned request an EGSFP FINAL payment in the amount of

. The undersigned certify

(a) they have read, understand, and agree to the EGSFP requirements in Part G - EGSFP AGREEMENT, (b) completed
construction or purchase of the eligible on-farm grain storage structure and/or drying/handling equipment as described in Part C;
(c) understand an FSA employee may inspect and verify construction of the on-farm grain storage structure is complete and/or
the drying/handling equipment is purchased, before or after a final EGSFP payment is disbursed (d) they understand the payment
amount requested will be based on applicant/co-applicant's share, cost-share factor and provisions in Part G, as well as subject
to the EGSFP NOFA.
22. Does the EGSFP PARTIAL payment request and EGSFP FINAL payment (if applicable) exceed the EGSFP estimated
request in Item 14?
YES

NO

If YES, the EGSFP payment increase must be approved in Part M.
23A. Applicant/Co-Applicant's Signature (By)

23B. Title/Relationship of Individual if Signing in 23C. Date of Applicant/
a Representative Capacity
Co-Applicant's Signature

PART L - COC/STC DETERMINATION - EGSFP FINAL PAYMENT (FOR COUNTY OFFICE USE ONLY)

24A. COC/STC Determination

Approved

24B. Signature of COC/STC
Representative

24C. Title/Position of COC/STC
Representative

24D. Date Signed

Disapproved

PART M - COC/STC DETERMINATION - REQUEST FOR EGSFP INCREASE (If Applicable)
(FOR COUNTY OFFICE USE ONLY)
25A. COC/STC Determination
Approved

Disapproved

26A. Signature of COC/STC Representative

25B. Final Approved EGSFP assistance if total of EGSFP payments exceeds
EGSFP assistance requested in Item 14.
$
26B. Title/Position of COC/STC Representative

26C. Date Signed

FSA-413 (03-16-23)

Page 5 of 5

NOTE: Privacy Act Statement: The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a - as amended).
The authority for requesting the information identified on this form is the Commodity Credit Corporation Charter Act. The information
will be used to determine eligibility to participate and receive benefits under the Emergency Grain Storage Facility Assistance
Program. The information collected on this form may be disclosed to other Federal, State, Local government agencies, Tribal
agencies, and nongovernmental entities that have been authorized access to the information by statute or regulation and/or as
described in applicable Routine Uses identified in the System of Records Notice for USDA/FSA-2, Farm Records File (Automated).
Providing the requested information is voluntary. However, failure to furnish the requested information will result in a determination of
ineligibility for the Emergency Grain Storage Facility Assistance Program.
Public Burden Statement (Paperwork Reduction Act): According to the Paperwork Reduction Act of 1995, an agency may not
conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control
number. The valid OMB control number for this information collection is 0560-0315. The time required to complete this information
collection is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The provisions of
appropriate criminal and civil fraud, privacy, and other statutes may be applicable to the information provided.
Non-Discrimination Statement: In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations
and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from
discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age,
marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights
activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by
program or incident.
Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign
Language, etc.) should contact the responsible Agency or USDA's TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the
Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.
To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://
www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the
information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1)
mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410;
(2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov. USDA is an equal opportunity provider, employer, and lender.

OMB Control Number: 0560-0315
Expiration Date: 09/30/2023

FSA-413-1
(03-16-23)

U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency

FOR COUNTY OFFICE USE ONLY
1. Administrative State
Name

CONTINUATION SHEET FOR EMERGENCY GRAIN
STORAGE FACILITY ASSISTANCE PROGRAM
(EGSFP) APPLICATION

2. Administrative County
Code

3. Program Year

Name

Code

4. Application Number

2023

PART A - CO-APPLICANT'S INFORMATION (Co-Applicant's must complete FSA-413-1 Continuation Sheet for EGSFP Application)

5A. Co-Applicant's Name (Person or Legal Entity)

5G. Co-Applicant's CCID Number (For County Office Use Only)

5B. Address Line 1

5H. Primary Phone Number

Home

Cell

5C. Address Line 2

5I. Alternate Phone Number

Home

Cell

5D. City

5E. State 5F. Zip

5J. Email Address (Optional)

5K. Do you meet the definition of an Underserved Producer?
YES

NO

5L. Co-Applicant's Signature (By)

5M. Title/Relationship of Individual if Signing in a 5N. Date of Co-Applicant's
Representative Capacity
Signature

6. I certify the producer listed in Item 5A is a U.S. Citizen, Resident Alien, Foreign Person or a legal entity, including a corporation,
LLC, LP, trust, estate, general partnership or joint venture, or similar type entity, comprised solely of persons who are U.S. Citizen,
Resident Aliens, or Foreign Persons and meet all other EGSFP requirements.
NO
YES
PART B - CO-APPLICANT'S INFORMATION (Co-Applicant's must complete FSA-413-1 Continuation Sheet for EGSFP Application)

5A. Co-Applicant's Name (Person or Legal Entity)

5G. Co-Applicant's CCID Number (For County Office Use Only)

5B. Address Line 1

5H. Primary Phone Number

Home

Cell

5C. Address Line 2

5I. Alternate Phone Number

Home

Cell

5D. City

5E. State 5F. Zip

5J. Email Address (Optional)

5K. Do you meet the definition of an Underserved Producer?
YES

NO

5L. Co-Applicant's Signature (By)

5M. Title/Relationship of Individual if Signing in
a Representative Capacity

5N. Date of Co-Applicant's
Signature

6. I certify the producer listed in Item 5A is a U.S. Citizen, Resident Alien, Foreign Person or a legal entity, including a corporation,
LLC, LP, trust, estate, general partnership or joint venture, or similar type entity, comprised solely of persons who are U.S. Citizen,
Resident Aliens, or Foreign Persons and meet all other EGSFP requirements.
YES

NO

FSA-413-1 (03-16-23)
NOTE:

Page 2 of 2

Privacy Act Statement: The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a - as amended).
The authority for requesting the information identified on this form is the Commodity Credit Corporation Charter Act. The information
will be used to determine eligibility to participate and receive benefits under the Emergency Grain Storage Facility Assistance
Program. The information collected on this form may be disclosed to other Federal, State, Local government agencies, Tribal
agencies, and nongovernmental entities that have been authorized access to the information by statute or regulation and/or as
described in applicable Routine Uses identified in the System of Records Notice for USDA/FSA-2, Farm Records File (Automated).
Providing the requested information is voluntary. However, failure to furnish the requested information will result in a determination of
ineligibility for the Emergency Grain Storage Facility Assistance Program.
Public Burden Statement (Paperwork Reduction Act): According to the Paperwork Reduction Act of 1995, an agency may not
conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control
number. The valid OMB control number for this information collection is 0560-0315. The time required to complete this information
collection is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The provisions of
appropriate criminal and civil fraud, privacy, and other statutes may be applicable to the information provided.
Non-Discrimination Statement: In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations
and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from
discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age,
marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights
activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by
program or incident.
Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign
Language, etc.) should contact the responsible Agency or USDA's TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the
Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.
To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://
www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the
information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1)
mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410;
(2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov. USDA is an equal opportunity provider, employer, and lender.